Cushing's syndrome of the orbit: congestive orbitopathy and optic neuropathy associated with steroids

A 56-year-old female with a history of chronic systemic steroid use for asthma control displayed orbital congestion, exophthalmos, a mild abduction deficit, and optic neuropathy. Laboratory workup was unrevealing. Neuroimaging showed increased orbital fat compartments, though the orbital fat was unremarkable on biopsy. The patient was diagnosed with iatrogenic Cushing's syndrome of the orbit and underwent orbital decompression. Early published literature declared this orbitopathy benign. However, newer cases describe more pathologic changes, suggesting the disease is diagnosed later and/or treatment is delayed.